声门上气道装置使用与气道高反应性儿童气道管理期间呼吸不良事件之间的关联：来自日本儿科麻醉困难气道（J-PEDIA）登记处的一份报告。
Association between supraglottic airway device use and respiratory adverse events during airway management in children with airway hyperresponsiveness: a report from the Japan Paediatric Difficult Airway in Anaesthesia (J-PEDIA) registry.
文献信息
| PMID | 42810867 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yuka Uchinami |
| 作者单位 | Department of Anesthesiology, Hokkaido University Hospital, Sapporo, Japan. |
| 期刊 | British journal of anaesthesia |
| SCI 分区 | Q1 |
| IF | 10.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 气道高反应性儿童面临更高的围手术期呼吸不良事件风险。尽管在选定的儿科人群中，使用声门上气道装置（SAD）与气管插管相比与更少的围手术期呼吸不良事件相关，但关于气道高反应性儿童诱导期气道管理的证据仍然有限。我们旨在使用基于倾向评分的治疗逆概率加权，研究气道高反应性儿童诱导期气道管理中SAD置入（相对于气管插管）与呼吸不良事件之间的关联。
方法： 这项多中心回顾性队列研究在日本儿科麻醉困难气道登记处的12家三级医疗机构（6家儿科医院和6家成人-儿科混合大学医院）进行，时间范围为2022年7月至2025年2月。我们纳入了年龄<18岁、接受全身麻醉且存在活动性上呼吸道感染、过去14天内上呼吸道感染、哮喘急性发作或家庭吸烟暴露的儿童。主要结局是呼吸不良事件的发生。
结果： 在27 844次诊疗中，分析了4878次（气管插管3005/4878 [61.6%]；SAD 1873/4878 [38.4%]）。调整后，SAD置入与较低的呼吸不良事件风险相关（调整风险比[aRR] 0.41；95%置信区间[CI] 0.19-0.62；P<0.001）、气道管理相关不良事件（aRR 0.32；95% CI 0.19-0.45；P<0.001）以及严重氧饱和度下降（aRR 0.47；95% CI 0.19-0.75；P<0.001）。
结论： 总体而言，在气道高反应性儿童中，麻醉诱导期间使用SAD与较低的不良呼吸事件风险相关。这些发现支持在临床适当时考虑使用SAD，同时承认可能存在残余混杂。
英文摘要
BACKGROUND: Children with airway hyperresponsiveness face higher risks of perioperative respiratory adverse events. Although the use of supraglottic airway devices (SADs) is associated with fewer perioperative respiratory adverse events than tracheal intubation in selected paediatric populations, evidence remains limited regarding induction-phase airway management in children with airway hyperresponsiveness. We aimed to investigate the association between SAD placement (vs tracheal intubation) and respiratory adverse events during induction-phase airway management in children with airway hyperresponsiveness using propensity score-based inverse probability of treatment weighting.
METHODS: This multicentre retrospective cohort study was conducted at 12 tertiary-care institutions (six paediatric and six mixed adult-paediatric university hospitals) in the Japan Paediatric Difficult Airway in Anaesthesia registry between July 2022 and February 2025. We included children aged <18 yr undergoing general anaesthesia who had an active upper respiratory tract infection, an upper respiratory tract infection within the preceding 14 days, asthma exacerbation, or household smoking exposure. The primary outcome was the occurrence of respiratory adverse events.
RESULTS: Of the 27 844 encounters, 4878 were analysed (tracheal intubation 3005 of 4878 [61.6%]; SAD 1873 of 4878 [38.4%]). After adjustment, SAD placement was associated with a lower risk of respiratory adverse events (adjusted risk ratio [aRR] 0.41; 95% confidence interval [CI] 0.19-0.62; P<0.001), airway management-related adverse events (aRR 0.32; 95% CI 0.19-0.45; P<0.001), and severe oxygen desaturation (aRR 0.47; 95% CI 0.19-0.75; P<0.001).
CONCLUSIONS: Overall, SAD use during induction of anaesthesia was associated with a lower risk of adverse respiratory events in children with airway hyperresponsiveness. These findings support consideration of SADs when clinically appropriate while acknowledging potential residual confounding.